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tv   Book Discussion  CSPAN  September 6, 2014 2:02pm-2:52pm EDT

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>> next up from the science pavilion at the national book festival sally satel. >> welcome to the national book festival. i am wendy maloney of the u.s. copyright office of the library of congress. before we begin please note we are recording this presentation for later wed casting. you are giving us permission to include you in the web cast. also please turn off all electronic devices. it is now my pleasure to introduce at the one. sally satel is a psychiatrist and president scholar at the american enterprise institute. from 1988 to 1993, she was an
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assistant professor at yale university where she means a collector. sally satel is the author of many scholarly articles and books including drug treatment:the case for coercion and how political correctness is corrupting medicine. in "brainwashed: the seductive appeal of mindless neuroscience," published by basic books in 2013, she and co-author scott lilienfeld reveal how many of the real-world application of human neuroscience gloss over its limitations and complexities, often obscuring the many factors in psychologies that shape our behavior and identity. sally satel and scott lilienfeld analyze what brain scans and other narrow technologies can and cannot tell us about ourselves and stress the complex nature of free will and personal responsibility. "brainwashed: the seductive appeal of mindless neuroscience"
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was a finalist for the 2013 los angeles times book prize in science. please welcome sally satel. ♪ >> great to see every one. thank you. apologies about the slide projector, most of my slides are not very busy. in fact, with my first slide, a copy of the cover of the book and to be honest right after we decided on that, i really thought of a better title. i wanted to be 50 shades of gray matter. that is not just a play on a popular novel but exclusively meant to evoke the concept of seduction. in this case the seduction into
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certain beliefs about behavior, that technology is like a brain scan and can lead us to and the ebitda me of seduction, i would say in neuroscience is -- a brain scan. the signature technology of modern neuroscience. someone says a brain scan has now replaced the atom as the symbol of science. the brain scan, is quite a wondrous thing. the reason i consider it a perfect storm of seduction is so many forces converged on it. it is absolutely dazzling technology. we won't go into that. it is very complicated. it is amazing technology and like all technologies it promises objectively and more scientific gays.
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it is about the brain, neuroscience is about the brain, which is a masterwork of the nature. 80 billion cells or neurons each communicating with thousands of others which is more connections than the milky way. it is the organ of the self and people tend to think understandably that it can reveal all kinds of secrets about human nature. it is a visual and we are highly visual primates, not something you could say about genes. everyone can see a brain scan. it is much harder to say nucleic acids. lastly there is an element, almost an element of surprise that accompanies brain scan. people tend to think, especially people who are not steeped in science or sophisticated in that realm, why should they be? the average person reading the science times, oh my gosh, it is
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in the brain, it is in the brain. that is of very key phrase. of course it is in the brain. all thoughts and emotions are in the brain. where else would the biological correlates of behavior, the motion and thinking be? the pancreas? they are in the brain. you see headlines, you have seen them, political bias affects the brain activity accompanied by a brain scan. anxiety is in the brain. of course it is in the brain. as a psychiatrist these kinds of headlines really annoy me. proof that depression is real because we have a brain scan to show that or anorexia or p t s d, now we know this suffering is real. we knew it before. we didn't need a brain scan to tell us that. we need a brain scan to tell us some things. mainly it is in the realm of research. not that many clinical applications but a few but in the realm of research and very
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good research but like so much of research would is filtered through the press into the popular media things get distorted. the phrase in the brain is seductive in another way because it carries an exculpatory don't blame me, don't blame my brain and also the notion that if global whites up, you hear the phrase lights up, which all that means is there is increased activity in a particular area of the brain. there's always activity in the brain. if there is not, you are did. anyway, if x lights up, then why behavior inevitably happens and that is not the case either. we will be talking a lot about that but you can see how that sort of conceit, the x lighting up and why inevitably following, it would be so appealing to trial lawyers and indeed now there is a whole new field
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called neuro law which is looking at understanding the criminal mind. is a nice story defense attorneys can tell. my client has this in his brain. he could not control himself. he could not form the intent needed to commit a crime. this is the miss reading of neuro imaging. sometimes without question people do have problems with their brains that renders them legally insane so that they are not culpable. all kinds of damages can happen to one axe cognitive apparatus rendering people either not culpable at all, or less culpable so that they are not
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excused but their sentence is mitigated. that happens clearly, but the point is at this point in time, and things might change as technology evolves but at this point in time we cannot distinguish who those people are. the brains can't. we can't distinguish an impulse that is irresistible from one that was not resisted. this is a key point i want to return to as well. another misconception of popular readings of brain scans is the notion that you can actually pinpoint emotions or complex or subtle emotions or complex feelings. that is simply not true. in fact, that kind of activity has led to the phrase, oversimplification of the reading of brain damages as
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being akin to a narrow phrenology. as if the brain is highly modular, specific areas of it are involved solely with certain kinds of reactions. clearly parts of the brain are more involved more heavily in mediating certain kinds of reactions. we know about the amygdala for example, famously invoked when we talked about fear reactions, but that particular part of the brain happens to figure prominently in processing perceptions of novelty or surprise so there's not a 1:1 correspondence. circuitry is where it is and all neurosciences know this and again, a lot of the problem is how popular neuro science has come through the media.
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some wonderful science journalists know the background and are very careful and others also less so. and there are neuro on for prince doors trying to to make a buck, things that have to do with education and the lot of fads that one has to be careful about. circuitry is where it is and that is where neuro scientists are focusing most of their energy, various regions interact with each other. it is enormously contemplated. it was basically a research tool. we were one foot into a 10 mile long journey on understanding the brain but nonetheless these brain images in the public's fear. and one can see politicians are
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so interested, and they offer neuro imaging in an attempt to advise their clients about how to make their candidates more appealing. this was from and popped it in the new york times in 2007 where candidates shown to swing voters and the reactions of those voters's brains were indicative of what the candidate would have to do to appeal to them more. this is neuro science at its most popular and dumbed down. marketers are very interested. a very clever title. a famous neuro marketer trying to tap into the brain, brain scans or other kinds of technologies that will reveal
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brain based data to tap into the brain to learn what consumers want, like cutting out the middleman which is you and going straight to your brain. certainly we would love to find a good ally detector and we had a whole chapter on this as well and frankly this is one of the few where there is proof of concept, there are neuro signatures that can distinguish between truth telling and lying, but it would be almost impossible at this time to apply it in the real world. in the laboratory setting with lots of control, there are some fairly good validity, then there it is the acquistion of how we engage the pool of temptation, and defense attorneys as mentioned before trying to prove that their clients lack maligned in 10 tour even free will. anyone who knows who these two
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guys are get a free book. i think i heard -- leopold and love. i think someone said that. i owe you a book. we devote a chapter to narrow marketing and lie detection and we try to tease the hype from what seems promising from technical obstacles in achieving an ultimate goal of being able to infer something about the mind from the brain and what are conceptual barriers to doing that. and pseudo neuro science. with that as background on want to focus on the part of the book that to me and i don't know if i speak for my co-author scott -- scott lilienfeld, but to me this is one of the most interesting things which is the culturally
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significant implications of our growing ability to explain behavior in neurological terms. in other words the better we get at describing human behavior through biology and we are only going to get better at it, how is that going to affect the way we think about human freedom? the freedom to choose our actions? i am going to exploit this through addiction. i am an addiction psychiatrist. that is my area of specialty. i can say with complete honesty that for at least 20 years, 20 years, i have been ferry, very interested in the way addiction is conceptualizes and portrayed and this is the way it is talked
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about now. in the media, educational campaign -- to water is over there. this is your brain literally on cocaine. a new frying pan. actually this represents a very legitimate and very interesting experiment. not interesting in terms of its results with you expect the results but the faster we can visualize the result is pretty amazing. this study has two paradigms, one, you take someone who has the cocaine problem and expose them in a brain scanner which happens to be a pet scan but the same general notion. this one uses metabolic activity, it uses blood flow but
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they both reflect increased enhanced activity in the brain. take someone who has a cocaine problem, put them in a scanning apparatus and you show them films, those little mirrors in these machines and the person looks up and they conceal film of people using cocaine, cocaine paraphernalia, and they experience a subject of desire to use cocaine and their brain will reflect in what we call the lower ward area, fresh activation. and that is the neuro correlate of their desire to use cocaine. when you show the same person a picture of a beech or a meadow or something neutral, you don't elicit the same kind of metabolic activity, in this case dopamine activity. the other version of its is you have two people, when is a
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cocaine user and the other is not, but you show them both the films of people using and you get this reaction, the person who has a cocaine history, but not in the person who has never used cocaine as you might expect. anyway, it has been replicated lot. it is great. the way it is described is that this is the brain being hijacked by cocaine, specifically referring to hijacking of the limbic system which is a complex and fairly old brain circuitry. it contains regions you may have heard of, the amygdala, the hippocampus and others and it mediates reward and memory and emotion but the language is that
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it hijacks the brain, that cocaine hijacks this limbic system and of course the implication, sometimes less of an implication, sometimes stated out right is that when someone's brain looks like this, effectively, they are out of control. they can no longer, they can no longer -- control over their actions and their drug use is involuntary. and these changes come as many experts called addiction a brain disease, a brain disease, because there are brain changes in the context of addiction. that is true. there are bring changes in the context of addiction but still, the label, brain disease, deserves a lot of scrutiny. first, changes in the brain are not a signifier of half ology. learning italian changes the brain, as you know. there is much plasticity
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involved with learning. alzheimer is changes the brain, but egyptian is not like learning italian. there are language lessons the don't take on the quality of a compulsion like the crack head, nor is it like alzheimer's with its own inexorable progression to dimension that is completely beyond the control of the sufferers. the brain changes of alzheimer's disease render the patient completely resistant to any rewards or sanctions. if you said to your grandmother i am going to give you $1 million if your memory doesn't deteriorate. i am going to shoot you if your memory deteriorates. it won't matter. but the brain changes of addiction, thank goodness, did not impair the capacity to be deterred. i realize that might sound especially for people who have known addicts, a little strange or it might sound not strange at
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all because people who live with people who use drugs can see the decisions they are making every day that makes more or less vulnerable. but in any case just going into the lab, we know that rewards and sanctions can and do modify the course of behavior which in some sense is the essence of voluntary, the behavior can be modified by its consequences. that sounds too theoretical so let me give you an example. these are vietnam vets. in june of 1971 president nixon became panicked that there would be a flood of veterans from southeast asia coming back to the inner-city and further inflame the heroin epidemic in big cities that were already under way and he was afraid -- it was true that at least half
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of all g is had tried to opium and heroin whereas -- about 15% to 20% may have been addicted so he was very concerned. so they instituted a program called operation bolden flow where everyone had a pea in a cup and everyone passed the test, did this to apps, passed the test and the few who didn't were given an extra week to clean up, then they came back to the united states. then a researcher at the university of washington named the robins followed these people for three years and was expecting to see high rates of
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addiction and once they were back home they would resume their habits, but only the 12% that used in three years that they had come back and that was very very surprising but also very encouraging and frankly it really lies at the heart of recovery and reasonable public policy for addiction which is the intelligent use of sanctions and rewards which we make very good use of in the criminal justice system. it is a different issue, i won't get into legalization or anything like that, taking the system as we find it to the extent that we can divert people from incarceration because of nonviolent drug crimes and put them in drug courts. we have been doing that for years and these are based on the principles of behavior which is
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that swift, certain but not severe sanctions can shape behavior. this has been going on for quite a while and quite successful. that is one example. there are many others in the book. if you just focus on the level of the brain, talked-about nucleus and the hippocampus. i apologize. you would not think about shaping behavior. when you are told something is of brain disease you think it is in voluntary. how do drug addicts, how do i work with my patients so they don't crave. we come up with strategies to allow them to what is called self binding, ways to basically put barriers between themselves and their drugs. you heard the common ones. stay away from people, places and things. thanks so much.
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deposit your paycheck, don't have money available. i had a patient who used to shoot up so every time he looked at his farm where he had tracks, had to wear long sleeve shirts. to arouse -- avoid boredom. this is the kind of thing people have to do. the point is this involves motivation. this involves conscious engage and. again if we focus too much at the level of the brain we won't pay attention to these things so that is what i am describing, patients sort of blind themselves not to the mass in this case but create barriers to their use, recognize situations,
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vulnerability like cocaine, but restrain yourself in some way. addiction is a good example, where scott and i called neuro centrism. where neuro science is popularized. nehr a centrism is the idea that human behavior can be best explained by looking solely or primarily at the brain but that level of analysis gives the most authentic, true, reliable understanding of the behavior. if you have alzheimer's disease, addiction, posttraumatic stress disorder, depression, no, the problems with the narrow centric view is you emphasize medication too much.
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i am not against medication but to think that methadone is the answer in and of itself is clearly not true. you are going to downplay the importance of psychology behavior, we can't afford to lose the mind in the age of brain science. when i refer to my mind i'm talking about feelings, thoughts, desires, memories, subject to the day. i don't want you to think we are falling into any kind of dual listen trapped, the mind is wholly dependent upon the brain, no questions there, all subjective experience is mediated through the brain, no brain, no consciousness, but it is important to realize that the physical rules from one level of analysis -- i am going to skip
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to my level. i apologize, you probably can't see that very well but breaking all the levels of analysis down, starting from the environment and ending up with the genes. it could end up at quantum physics. we can't yet use the physical rules from the cellular level to predict activity at the psychological level. if you want to understand, if you are reading a book and want to understand what the tax means, you don't subject the ink to a chemical analysis. that is not the level that is going through to inform you about the meaning of the book. there are different levels of analysis and the important thing is some questions are answered better at one or more of these levels. others are answered at others. they are not right or wrong. does the addiction affects the brain? of course it does but if we stay
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at that level we are going to miss a lot. okay. it is not just addiction but biological explanations of complex behavior in the courtroom as well, counting on jurors to debt produced as well. as i mentioned before, again, there are certainly cases where people's brains are defective and cannot be held accountable. it is just that brain images are not helpful in distinguishing who they are. i have to say maybe that will change at some point but it can be highly misleading. biological explanations in general influenced the way we think of that responsibility over action. there have been many interesting studies explaining behavior,
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explaining behavior in biological terms and comparing it to psychological terms. my brain -- describing -- that is the big flip, describing -- behavior or a genetic explanation. people are much more likely to attribute less blame the the person if they committed a crime and this is an explanation given for their behavior. the impulse to punishes a lot less severe when people understand it as being a behavior that is caused by a brain problem as opposed to a childhood problem but this can also backfire as people accept a biological explanation for mental illness and substance abuse, the desire for social distance and the stigma enhances, they have less faith that treatment therapy will work and they believe individuals are
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more dangerous, so this is important to know. is important to know the implications of how we describe behavior. it is not -- i am not telling you how you should describe behavior, you don't want to manipulate explanations so as to the listed specific kinds of reactions. you have to be truthful. but it is interesting how these explanations do affect fundamental intuitions of human agency. and my point is simply that they can be manipulated. let's go a little bit deeper, 15 more minutes and leave a little time for discussion but i want to go on a little deeper.
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when lawyers use brain scans in capital cases, they are making the point that their clients couldn't form and in tents or their clients couldn't reason properly, they had some poor patrol. the implication is that the fault of the circumstance is most people can control themselves, most people do know what they are doing, most people can be the third but not my client. some neuro scientists and philosophers are taking -- going a step further and arguing that no one has the capacity for choice, none of us could act other than we did and all of us, not just criminals i not in control of our actions at any
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point. you will recognize this of course as the fiendish ancient debate about free will which we are not going to resolve here. just so you know. many neuro scientists claim we don't have real -- free will. this is not new. this debate has been going on for centuries but they do argue that neuroscience will make this clear, that neuro science will finally resolve the free will debate. that debate, neuro science will finally clear of the free will debate. this brings us to another very interesting aspect, the implications for morality more generally, not just whether individual could or could not control consoles or should be responsible. but whether the concept of responsibility at all is a
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coherent one and that gets us back to our boys. 1924, everyone knows the story in hyde park, chicago the swede to brilliant kids wanted to commit the perfect crime so they found a 14-year-old boy and killed him and drove him to indiana, put his body in a drain pipe, went home and played cards, called the family of the child's and said they needed ransom and we're very pleased with themselves and thought that they had gotten away with it. they didn't. three days later one of the drop their glasses and they traced it to leopold and loeb and their families, and famous attorney clients, who the next year when john to inherit the wind.
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so it was a monthlong trial, literally 90 years ago, today, and at the end of its there was a 12 hour summation, basically arguing for life in prison as opposed to hanging. he did succeed although the judge said it had to do with their use and not his argument. the argument was right out of the determinist playbook. in other words -- i will tell you what he said. why did they kill little bobby franks? not for money, not for spite, not for hate. they killed him because they were made that way. they were nature's victims. this is the essence, i am sure you remember this from philosophy 101. the notion of determinism which is that each act, we perform, criminal or otherwise, follows
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from a cause and given the same condition, the same result will flow every time. again, we are talking of all the causes that go into a person, your environment, your genetic history and all these in the context you are in at the moment is the idea is all these impinge on in individual so at the moment of having to make a decision there is basically you faded to make one choice. there is no real choice. shoes suit over salvador murder over mercy, there was no choice to be made because up until that moment of decision you couldn't have chosen otherwise based on the whole history of -- this will cause. i am assuming that sounds
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familiar. in this view there is no blame because you couldn't have done otherwise. you acted based on all the forces impinging on you. certainly that is not an intuitive view of how we act but on the other hand it is true that much of our behavior is caused and much is caused in unconscious ways. that is true but how is neuro science -- the bottom line where it says victims under all circumstances, the top one is clarence darrow. the bottom is under a scientist. they were all victims of circumstance. if that is true, then what happened? this goes away. there is no blame. it means we have to change our criminal justice system radically, turn it into one that
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is highly utilitarian, we might put people in jail but it is to deter them from acting again and others would observe how we punish them, to contain dangerous people and to rehabilitate them, but no punishment. these debates have been going on for a long time. and with the addition of neuroscience they lead up to this question. maybe you can't read it. is there a way to preserve moral responsibility in a world in which all events leading up to the moment of choice determine what the choice will be and that we get at understanding of the neural pathways will actually see the process. this is what happens to me when i think of that. it is cutoff one and ends in
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tears. the point is that neuroscience is not resolving it either, the way philosopher's dealt with it is to just think about the kinds of -- the kinds of freedom that are necessary to make the choice. of the kind of freedom that you think is necessary is the kind that is completely and cause, where people essentially operate in a vacuum which is hard to imagine how that can happen, all your behavior is archons blue some you are aware of, some you are not so aware of but unless we live in the causal vacuum then there is no such thing as ultimate free will. those people are called hardy tennis and they do go towards the utilitarian view of the criminal justice system then you have a compatible view that says as long as people can deliberate and plan, to change their mind,
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that is enough freedom for people to be considered to have free will. if there is something wrong with your brain that you can't reason or deliberate or respond to the currents or respond to reason, maybe you as an individual to have your freedom compromised and you should be excused, but as an species we do have free will. i don't know how you come down on that but neuroscience one not help you resolve it. i should end there. i only have five more minutes but i have more to say. the book is the culture book. i considered it much more a culture book than a science book. i think it is inevitable, biological manifestations and explanations and mechanisms are understood, they will have enormous therapeutic benefits.
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we didn't talk about the benefits and there's a talk later today in this room about neuro science and i assume we will talk about that as well and it will have -- it is the final scientific frontier. you shouldn't get seduced into thinking too mechanically about human nature simply because we are learning more and more about how we function. [applause] >> there might be time for two questions. is there -- >> i don't think -- the question was does bay a work? the short answer is it works for
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whom it works. most treatments don't have the greatest rates. so that the individual level it can be life-saving. the average person won't start drinking right away. the treatments that work the best, we don't use these contingency rewards and sanctions very much which is a shame. unless you are doctor or a pilot and use your license we have all kinds of built in contingencies like you have something to lose and you will lose unless you shape up and the rates of recovery of professionals are 95% because there is so much to lose and these are obviously people with skills as well.
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but you are dealing with a different kind of population. but they do much better, professionals do much better in terms of recovery when there are contingencies attached to them as well. >> could you -- could you talk a little bit about food addiction? you said you are from yale. and that is a marriage of survey of behavior with neuro science and so forth but that is a place to impact legislation and the prepared food industry. >> the picture comes from an article i wrote about that last year. there was a research study that got an award amount of attention, really bad quality work, rats are find but there is so much to extrapolate to
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humans. anyway, cocaine, oreos were as addictive as cocaine and the idea was because they made this they concluded this, the same neuro signatures, this is true with humans as well, the reward pathway that i mentioned is elicited by food and sex and anything pleasurable and cocaine and it is very facilites think to say food and diction is like a cocoon. what it shows us is people have a desire there is anticipation and the desire, the fact register anticipation more than it does sexual desire. and the same principles apply as they do to addiction in the sense that any behavior that is habitual to the extent that we
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can learn the queues that make us more or less vulnerable and with motivation and other kinds of techniques we can overcome them. i am not arguing that some of the same mineral mechanisms are engaged but i would argue against the person is then rendered helpless and i juicing you are exactly right that with a lot of product liability and effort for big food, this is potentially a trial lawyer's dream, to make it as analogous to addiction as possible and that would be a real abuse of neuro science. just one more. >> a little confused. i am addicted to ice-cream. if it is not in my brain, where is that addiction located?
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>> that is one of the first things, of course it would be in the brain. that is exactly where it is and that is where everything is. almost trivially true to say something is in the brain and there are things in the brain we haven't found. if you recall this awful crime in 2001 of andrea yates, this poor woman with postpartum psychosis and drowned her kids, there was no brain scan in her trial. there was none. even if they attempted to bring one in now it probably wouldn't reveal much. we can't even make the most significant psychiatric diagnoses like postpartum psychosis, bipolar, schizophrenia. we can't make those diagnoses with great certainty based on brain scans. we will, i am sure we will with other information, genetic information is also difficult, so many genes, 100 genes
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involved but we will get there. we are not there yet. it is limited technology and responsible marrow scientists know that and cringe when they see it applied so sloppily in the public realm. they cringe but we wrote the book. i guess we should end. one more? >> do you believe that there is a pre genetic disposition that people are born with -- to have addictions? if you were an alcoholic and you are recovering from that, you need to do something else? >> no question there are genetic predisposition this.
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and we have a certain pop called, there is a lot. some people find it disgusting, some can't metabolized. and they can't metabolize alcohol very well but there's not going to be a lot of alcoholism simply because -- if your parents are alcoholics some people say don't even try it. why put yourself in that position? not like your mother is hunting and you have that gene, not that kind of simple genetic transmission at all. and in this case addressed in the most simple way, you don't even go near it at all or pace yourself, all kinds of strategies a person can use so that if they do feel things are getting out of control they can pull back and i must tell you most people pullback.
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clinicians' tend to see people who have trouble. something called the clinician's illusion is a problem i have engaged in myself where we extrapolate too vigorously from people we see in the clinic to people in the general universe. we saw this after 9/11. there was an assumption that new york city would be traumatized. the amount of money that went into mental health services was astounding and well-meaning clearly and it turned out that -- you could have had a severe psychiatric reaction. if you knew someone who died you were vulnerable but the vast majority of people were upset but not pathological at all. people are resilient. that is not what psychiatrists see. we see the people who have
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trouble coping. we see addicts who don't recover on their own. so many to -- that is not to say you don't come in for treatment. if you're having trouble coming right away. don't wait for to play out because it all kinds of things could happen but the natural history for people to recover on their own, on the optimistic note i will stop. [applause] ♪ >> sally satel spoke to booktv about her book "brainwashed: the seductive appeal of mindless neuroscience" nestle can. you then watch that online at next from the national


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